burt efficacy in improving upper extremity strength and function during post-stroke inpatient rehabilitation

Conditions: Stroke; Stroke, Acute; Cerebral Vascular Accident; Cerebral Vascular Accident (CVA)/Stroke

Summary: the barrett upper extremity robot (burt) is an fda-approved upper extremity robot that assists patients with both passive and active range of motion while providing adjustable resistance (barrett_medical. robotic assist rehabilitation made easy. https://medical.barrett.com/). activities are directed by therapists and encourage patient involvement through video game activities providing active proprioceptive, vibrational, visual and auditory feedback. engaging and colorful games are beneficial in holding patients' interest, and gravity assistance may also allow for increased repetition in the face of patient fatigue. in this prospective study, the investigators will determine if a standardized burt upper extremity (ue) program can be consistently implemented within an acute inpatient rehabilitation facility (irf). in addition, the investigators will see if patients who receive burt have improved ue mobility and function as a result. the investigators will also study the perceived enjoyment and value of the intervention by patients, and perceived value by therapists. because burt therapy is able to provide more repetitions of upper extremity movement in a shorter length of time than conventional therapy, the investigators hypothesize that patients who participate in neuro re-education activities using burt will achieve greater improvements in strength, upper extremity function, fine motor coordination, activities of daily living and mobility during their time in an irf than patients receiving conventional therapy. in this study, eligible patients admitted to sunnyview rehabilitation hospital (srh) for rehabilitation following stroke will be randomized to receive conventional or burt therapy. meaningful clinical benchmarks for upper extremity function, tone, fine motor coordination, activities of daily living and mobility will be assessed using the upper extremity motor assessment scale (ue-mas)(zelter, 2010), manual muscle testing (mmt), modified ashworth scale (mas) (figueiredo, 2011) and the 9-hole peg test (9hpt)(figueiredo, 2011). the investigators also hypothesize that patients in the burt cohort will report greater value/usefulness and interest/enjoyment.


Eligibility criteria:
inclusion criteria: * inpatient at sunnyview rehabilitation hospital * \>/= 18 years * unilateral stroke * ue paresis affected arm with 3-/5 or less manual muscle testing throughout exclusion criteria: \>30 days post stroke * severe neglect * bilateral stroke * prior stroke with residual deficits * patients receiving prism adaptation treatment * comorbid neurological disorders * upper limb comorbidities that could limit functional improvement (ue arthritis pain, ue fracture, fixed contracture not allowing for proper device alignment) * severe shoulder subluxation that cannot be accommodated by the device * severe osteoporosis * unable to follow simple directions * unable to tolerate sitting 30 minutes * expected length of stay (los) \< 15 days.

Keywords: burt upper extremity function inpatient rehabilitation upper extremity robotics